Provider Demographics
NPI:1164615761
Name:JM FAMILY DENTISTRY
Entity Type:Organization
Organization Name:JM FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSETTE
Authorized Official - Middle Name:MELON
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-278-2119
Mailing Address - Street 1:349 CALLE MENDEZ VIGO STE 2
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4973
Mailing Address - Country:US
Mailing Address - Phone:787-278-2119
Mailing Address - Fax:787-278-2196
Practice Address - Street 1:349 CALLE MENDEZ VIGO STE 2
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4973
Practice Address - Country:US
Practice Address - Phone:787-278-2119
Practice Address - Fax:787-278-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2129261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental